Healthcare Provider Details

I. General information

NPI: 1801974175
Provider Name (Legal Business Name): GWINNETT PULMONARY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 PROFESSIONAL DR STE 350
LAWRENCEVILLE GA
30046-3370
US

IV. Provider business mailing address

631 PROFESSIONAL DR SUITE 350
LAWRENCEVILLE GA
30046-7651
US

V. Phone/Fax

Practice location:
  • Phone: 770-995-0630
  • Fax: 678-205-2404
Mailing address:
  • Phone: 770-995-0630
  • Fax: 678-942-5984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number326200
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number326200
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number326200
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number326200
License Number StateGA

VIII. Authorized Official

Name: DR. LAWRENCE KAPLAN
Title or Position: PHYSICIAN IN CHARGE/OWNER
Credential: MD
Phone: 770-995-0630